考量多重利害關係人對於乳癌自費藥物選擇之決策分析

Abstract

根據衛福部公布110年癌症登記報告，癌症已連續41年居國人死亡首因。其中，乳癌為國內女性好發癌症之冠，每年有逾萬位婦女罹患乳癌，逾2,000名婦女死於乳癌，相當於每天約31位婦女被診斷罹患乳癌，6位婦女因乳癌而失去寶貴性命。在台灣健保制度下，雖然基本癌症治療有給付，但隨著新藥上市及健保財務吃緊，癌症新藥審查愈趨嚴格。平均而言，癌症新藥申請健保給付所需時間較一般新藥長近一倍。即便獲得健保給付，給付範圍涵蓋率僅三成病患，且健保給付藥物未必適用所有病患。因此，對乳癌病患而言，自費用藥是無可避免的選擇之一。

在自費藥物市場中，雖然最終決策權在病患手中，但實際上這一過程涉及多方利害關係人的影響。醫師和護理人員在其中扮演著關鍵角色，通過醫病共享決策來幫助病患了解其疾病診斷及可選藥物。對於藥廠來說，也時常在思考如何可以提供更實用的衛教工具給護理人員來向病患做解釋，或者是透過媒體露出以及舉辦民眾衛教來增加病友對於癌症的病識感。

本研究主要探討多重利害關係人對於乳癌自費藥品選擇決策歷程，如何透過多重利害關係人對於自費藥物的看法以及影響決策的因子，協助藥廠優化行銷策略，並結合科技進步與網絡發展，促進醫病溝通成效，提升病患對癌症及自費藥物的認識。

本研究通過不同利害關係人的參與和意見交流，分析了乳癌自費藥物決策的各個構面及相關準則和因素。研究發現，關鍵決策點包括知識傳遞、疾病診斷、醫病溝通和輔助措施等構面。知識傳遞和醫病溝通在臨床實務中扮演重要角色，對於藥廠管理者而言，促進知識傳遞及提供醫病溝通輔助工具非常重要，這不僅能提升病患對藥物的認識，還能增加藥物的處方量。總結來說，多面向的知識傳遞和有效的醫病溝通對於優化癌症自費藥物決策和改善治療效果至關重要。

According to the 2021 Cancer Registry Report published by the Ministry of Health and Welfare, cancer has been the leading cause of death among the population for 41 consecutive years. Among these, breast cancer is the most common cancer affecting women in the country, with over 10,000 women diagnosed each year and over 2,000 deaths annually. This equates to approximately 31 women being diagnosed and 6 women dying from breast cancer each day. Although basic cancer treatment is covered under Taiwan's National Health Insurance (NHI) system, the financial strain on the NHI and the introduction of new drugs have led to increasingly stringent reviews for new cancer drugs. On average, it takes nearly twice as long for cancer drugs to receive NHI coverage compared to other drugs. Even when coverage is granted, it only applies to about 30% of patients, and the covered drugs may not be suitable for all patients. Therefore, for breast cancer patients, paying out-of-pocket for medications is often an unavoidable option.

In the market for Self-Pay medications, although patients ultimately make the final decision, the process is influenced by multiple stakeholders. Doctors and nurses play a critical role in helping patients understand their diagnosis and treatment options through shared decision-making. For pharmaceutical companies, there is a constant consideration of how to provide practical educational tools for healthcare providers to explain treatments to patients, or how to use media exposure and public education to increase awareness about cancer among patients.

This study primarily explores how multiple stakeholders influence the decision-making process for Self-Pay breast cancer medications. By examining stakeholders' perspectives and the factors influencing these decisions, the study aims to help pharmaceutical companies optimize their marketing strategies. It also aims to enhance communication between healthcare providers and patients, leveraging technological advancements and network development to improve patient understanding of cancer and out-of-pocket medications.

Through the participation and opinion exchange of various stakeholders, the study analyzes the different dimensions, criteria, and factors involved in the decision-making process for Self-Pay breast cancer medications. The research finds that key decision points include knowledge transfer, disease diagnosis, doctor-patient communication, and supportive measures. Knowledge transfer and doctor-patient communication play vital roles in clinical practice. For pharmaceutical managers, promoting knowledge transfer and providing tools to support doctor-patient communication are crucial. This not only enhances patient understanding of the medications but also increases prescription rates. In summary, multi-faceted knowledge transfer and effective doctor-patient communication are essential for optimizing the decision-making process for out-of-pocket cancer medications and improving treatment outcomes.